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PubMed1987

[Three cases of scalp arteriovenous malformations].

Three cases of scalp arteriovenous malformation (AVM) are presented and the pertinent literature is reviewed. Case 1 was a 50-year-old male who was admitted to hospital with a pulsatile mass involving the right parietal region. Selective angiography revealed a scalp AVM fed by bilateral superficial temporal and right occipital arteries. The AVM was embolized with Gelfoam pieces through catheterization and there was no evidence of recurrence of the lesion after follow-up period of three years. Case 2 was a 25-year-old male who was noticed to have a birth mark in the left occipito-parietal region and was hospitalized with a pulsatile gradually expanding mass after an episode of minor trauma in the same region. Selective angiography revealed a cirsoid type scalp AVM fed by bilateral superficial temporal and occipital arteries, and the authors performed a total resection of the mass because of selective Gelfoam embolization was not successful. Case 3 was a 49-year-old male who was hospitalized with the chief complaints of left tinnitus and pulsatile left supra-auricular mass. There was no history of trauma. Selective angiography revealed a scalp AVM fed by the left superficial temporal and occipital arteries and the authors performed a selective Gelfoam embolization and this was successful, but three months later, the AVM recurred and mainly fed by instead this was the left posterior auricular artery. Preoperative selective Gelfoam embolization followed by a total resection of the AMV with minimal blood loss.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Primary scalp cancer in Singapore.

Cancers of the scalp are uncommon. Owing to their unique site they pose problems in surgical treatment. A retrospective study of all scalp cancers notified to the Singapore Cancer Registry over 17 years has shown that squamous cell carcinoma is the most common cancer followed by basal cell carcinoma. Other cancers are sweat gland carcinoma, angiosarcoma, dermatofibrosarcoma protruberans, liposarcoma, fibrosarcoma and malignant lymphoma. Scalp cancers are more common in Chinese and very rare in Indians. There is no difference in the incidence between the sexes. The surgical treatment and reconstructive techniques employed in 52 patients are described. When localised, scalp cancers are managed like other skin cancers but once they invade bone, they become aggressive and are difficult to eradicate. Wide radical excision provides cure and the skull bone if involved should be removed.

Adolescent↗
PubMed1986

[Autoimmune thrombopenia and pregnancy. Value of counting scalp platelets].

Fetuses of mothers who have auto-immune thrombocytopenia are at risk in utero of having transitory thrombocytopenia. There is no maternal biological test that can predict the numbers of platelets in the fetus. This count of platelet numbers can be estimated from taking fetal blood from the scalp at the onset of labour, and if the count is less than 50 X 10(9) per litre a caesarean operation is indicated. The authors report a series of 23 pregnancies where the mother had auto-immune thrombocytopenia and where fetal scalp blood sampling was indicated. This series has been compared with a previous series of 14 pregnancies where scalp sampling was not carried out. There was no case of severe fetal thrombocytopenia after scalp sampling was carried out and where the best way of delivery could be predicted early enough in each case. The ease of taking the sample and the safety and reliability of it for estimating the degree of thrombocytopenia in the fetus and thus deciding the method of delivery makes us believe that this method should be used more frequently in cases of maternal thrombocytopenia that appear late in pregnancy.

Autoimmune Diseases↗
PubMed1986

Maternal-fetal pH difference and fetal scalp pH as predictors of neonatal outcome.

The purpose of this study was to determine if interpretation of fetal scalp pH values would be enhanced by concurrent measurement of maternal venous pH. The last fetal capillary pH obtained before delivery was compared with simultaneous maternal-fetal pH difference as predictors of neonatal outcome assessed by five-minute Apgar scores. Fetal scalp pH and maternal-fetal pH difference were significantly correlated with r = -0.72 (P less than .0001). The acidotic fetuses born to acidotic mothers had low maternal-fetal pH differences, and all were nondepressed at birth. A 33% reduction in false negatives was found using maternal-fetal pH difference instead of scalp pH alone. Errors in interpretation of fetal scalp pH can be reduced by the use of maternal-fetal pH difference.

Apgar Score↗
PubMed1985

Failure of scalp hypothermia to prevent hair loss when cyclophosphamide is added to doxorubicin and vincristine.

Scalp hypothermia can prevent alopecia caused by low doses of doxorubicin alone or in simple combinations. The technique was used in 60 patients with breast cancer (24 receiving adjuvant therapy; 36 with advanced recurrent disease) receiving chemotherapy with iv doxorubicin (40 mg/m2) and vincristine (1.4 mg/m2) on Day 1 together with oral cyclophosphamide (200 mg/m2) on Days 2-5. The patients' desire to continue scalp hypothermia, reflecting their perception of benefit, and an objective assessment of hair retention were the study end points. The mean number of cycles of chemotherapy given (6.1 in patients receiving adjuvant therapy; 3.8 in those with advanced disease) exceeded the number of cycles with hypothermia (2.1 in patients receiving adjuvant therapy; 1.6 in those with advanced disease); no patients retained enough hair to encourage them to continue scalp hypothermia throughout chemotherapy. All patients were rated as having poor hair retention. Scalp hypothermia is ineffective when used with combinations of drugs, each causing alopecia, or with high doses of doxorubicin.

Alopecia↗
PubMed1976

Study of some minerals in normal Egyptian scalp hair.

Scalp hair of 128 normal individuals of both sexes and of differing ages was examined for its mineral content by flame photometric and colorimetric procedures. The results obtained revealed that sodium and potassium may be considered as sex specific and of value as a medico-legal sign, while no marked difference was observed between male and female calcium content. The values of scalp hair copper were found to be slightly higher in females than in males. Similarly the mean value of scalp hair iron was found higher in females than in males, especially during the female reproductive period. Regarding the scalp hair phosphorus content, it has been found that a relationship between phosphorus and calcium does exist.

Adolescent↗
PubMed1984

Skin cancer incidence among children irradiated for ringworm of the scalp.

A series of about 2200 children who received X-ray treatment for ringworm of the scalp (tinea capitis) during the 1940s and 1950s, and a comparable group of 1400 treated without X ray, have been followed by mail questionnaire for an average of 26 years since treatment to tabulate the incidence of skin cancer. The X-ray treatment consisted of 300-380 R to five overlapping fields on the scalp, to cause complete depilation. This delivered doses of 300-600 rad to various portions of the scalp, with lower doses to the skin of the face and neck. In the irradiated group, 41 persons have had one or more basal cell carcinomas of the scalp or face while only three have been diagnosed in controls. There was a high prevalence of multiple skin cancers in the irradiated group (80 lesions among 41 cases). The minimum latent period for radiation-induced skin cancers was long--about 20 years--and this may be attributable to the young age of the population. The skin cancer risk was particularly pronounced on the face, where there would be more UVR exposure in addition to X-ray exposure. Lightness of complexion proved to be an important factor in the skin cancer risk. In addition, skin cancers were found only among caucasians, even though 25% of the study population were blacks. These findings suggest that UVR exposure levels or sensitivity to such exposure interact with ionizing radiation exposure in defining skin cancer risk.

Adolescent↗
PubMed1984

Septic dermatitis of the neonatal scalp and maternal endomyometritis with intrapartum internal fetal monitoring.

During a 3-month period, 1,062 mother-infant pairs were studied for infections following internal fetal monitoring during labor. Six infants (0.56%) developed septic scalp dermatitis at the site of the spiral electrode application. Factors associated with septic scalp dermatitis included the number of vaginal examinations, the use of an intrauterine pressure catheter or of more than one spiral electrode, and fetal scalp blood sampling. Maternal diabetes and endomyometritis were also associated with an increased risk of scalp infection. The duration of spiral electrode use and duration of ruptured membranes were not significant risk factors. Endomyometritis was documented in 41 mothers, an overall incidence of 3.9%. In women whose babies were delivered by cesarean section, the incidence of endomyometritis was 28/117 (23.9%). Using multivariate analysis by logistic regression, endomyometritis was associated with the number of vaginal examinations during labor but not with the duration of internal monitoring, duration of labor, or duration of ruptured membranes.

Adult↗
PubMed1983

Fetal scalp temperature during labor and its relation to acid-base balance and condition of the newborn.

Fetal scalp temperature and fetal-maternal temperature gradient were studied during well-established labor in a group of 97 patients using a technique that ensured at the same time the adhesion and the thermal insulation of the probe. In 78 infants with a one-minute Apgar score of 7 or above, a positive gradient of 0.2C was maintained throughout labor between the warmer fetal scalp temperature (37.3C) and the maternal rectal temperature. Periodic drops of temperature related to the uterine contractions occurred in only 43% of the cases. In a group of ten infants with a one-minute Apgar score of 6 or below, the fetal-maternal gradient was significantly different from this schema. There was an inversion of the gradient, the fetal scalp temperature becoming cooler (36.9C) than the maternal rectal temperature. The gradient was -0.2C at the beginning of the study and -0.5C 20 minutes before delivery. Periodic drops of temperature with uterine contractions were constant. In dead fetuses, fetal scalp temperature was much below that of the mother and this difference increased steadily until delivery. A good relationship was found between fetal-maternal gradient and the pH of the umbilical artery blood sampled at birth. When the mean gradient was 0.2C +/- 1 SD, pH averaged 7.27; in the group below 1 SD, mean pH was 7.19 (P less than .01).

Acid-Base Equilibrium↗
PubMedDate not supplied

Scalp vein sign in Paget's disease of bone.

Prominent scalp vein dilatation was observed in 55% of 71 patients with Paget's disease of bone involving the skull. None of 137 pagetic patients without skull involvement showed visible dilatation of their scalp veins. Following disease suppression with oral etidronate disodium therapy, 21 of 30 patients showed diminution in their scalp vein distension. This "scalp vein sign" may serve as 1 marker of pagetic skull disease and provides another clinical feature of disease activity.

Dilatation, Pathologic↗
PubMedDate not supplied

Misuse of scalp hypothermia.

Scalp hypothermia has been introduced to reduce the temporary epilation associated with certain cytotoxic drugs. This has improved compliance with drug delivery for some patients. It is currently not recommended for use in those tumors with a high prevalence of scalp metastasis, ie, leukemia and lymphoma. We have treated a patient for mycosis fungoides who demanded use of a "cooling cap" while undergoing consolidation chemotherapy. Cutaneous disease recurred on the scalp, with no other evidence of mycosis fungoides. Caution should be used in reducing drug delivery to the scalp while treating tumors manifesting cutaneous stem cell tumor nests.

Antineoplastic Agents↗
PubMed1980

Replantation of the totally avulsed scalp.

A case report of successful microvascular replantation of a totally avulsed scalp is presented. The scalp itself, in good condition, was used as a free flap. Following operation, the right temporal artery was patent; the left was not. Repair of the left temporal artery was not attempted but large thrombi were milked from the scalp veins. Excellent perfusion of the scalp was provided through the right side. Hair growth began soon after operation, spotty at first but eventually excellent.

Accidents, Occupational↗
PubMedDate not supplied

[Accidents that can occur during fetal direct electro-cardiographic recording. Concerning a fracture of the scalp electrode (author's transl)].

The authors report a case of fracture of a double spiral scalp electrode. One of the two spirals stayed in the scalp tissue when the electrode was being removed. This spiral was localised by X-Rays and was removed under local anaesthetic. There were no complications. No similar case of such an accident has been reported in the literature and this is the first happening in our 2,472 cases of monitoring. Of the other serious complications which are mentioned in the literature, abscess of the scalp is the most frequent at 0.4 per cent (9). We have had no complications in 2,472 cases of monitoring. The outcome of such an abscess is usually quite benign, but there have been two cases of septicaemia followed by death reported. The complication of infection is serious and has to be treated carefully by disinfection. Two other complications have been noted and that is, tearing or ripping off a little of the scalp (2 cases in 2,472 monitorings). Spinal fluid leakage has been reported when an electrode was placed on a fontanelle and haemorrhage. Most of these complications took place when the clip electrodes which have now been abandoned were used and, their frequency being rare, does not invalidate the definite advantages of direct monitoring of the fetus in labour.

Abscess↗
PubMed1995

[Microsurgical reimplantation of scalp: case report].

With the introduction of modern techniques in plastic surgery, severe injuries concerning the extremities and scalp are now amenable to surgical treatment. Successful reimplantation of the scalp either total or partial have been rarely reported in the literature. We treated a patient with avulsion affecting 2/3 of the scalp, the right ear and a cutaneous flap on right side of the face. We report here the initial care and operative procedure. The avulsed scalp was revascularized through microanastomoses of the temporal artery and vein. The reimplantation was well succeed and cosmetic results were satisfactory.

Accidents, Occupational↗
PubMed1975

Cortisol levels in fetal scalp, maternal, and umbilical cord plasma.

The purpose of this study was to investigate cortisol levels in the fetal circulation prior to delivery. Fetal scalp plasma cortisol levels during labor were significantly lower than those in maternal peripheral plasma but significantly higher than those in cord plasma at delivery. Cortisol levels in fetal scalp plasma did not correlate significantly with those in either maternal or cord plasma. The greater cortisol concentrations in fetal scalp plasma relative to those in cord plasma could have been transient increases caused by fetal adrenal response to the stress of the scalp sampling procedure. There was a significant correlation between cortisol levels in maternal and cord plasma, which may mean that a considerable part of the cortisol in the fetal circulation at delivery is of maternal origin.

Apgar Score↗
PubMed1995

[Successful scalp replantation--a case report].

Scalp avulsion is a rare injury. Prior to the introduction of microsurgery, replantation usually resulted in partial or total necrosis. We present the case of a 19-year-old women with a severe scalp avulsion injury. The scalp was successfully replanted. For the relief of pressure to the replanted scalp we used a halo-fixateur externe.

Adult↗
PubMed1996

Treatment of scalp arteriovenous malformation.

We report seven patients with scalp arteriovenous malformations, including two patients with lesions > 10 cm in diameter, who were successfully treated. The principal complaint of each patient was a deforming mass. Each of four patients had a history of blunt traumatic injury. The lesions, each consisting of the nidus, feeders, and draining veins, evolved in all patients. The nidus consisted of fistulae, which exhibited various angioarchitectures as revealed by angiography. A hemangiomatous component was histologically recognized in one patient. In five patients, in whom the lesions were relatively small and whose nidi included only large fistulae, the malformations were remedied by surgical intervention alone or were cured with embolization alone using liquid adhesives. In the two patients with lesions > 10 cm, the nidi consisted of numerous large fistulae and plexiform fistulae in one patient and plexiform fistulae and a hemangiomatous component in the other patient. These patients were treated with a combination of transarterial embolization and surgical intervention. Preoperative embolization greatly reduced blood loss during resection. Total excision and scalp reconstruction using a soft tissue expander were performed in both patients. The cosmetic results were excellent in all of the patients, and no recurrence has been recognized during the follow-up period, which ranges from 31 to 99 months. The treatment of scalp arteriovenous malformations should strive to improve deforming features and to attain a permanent cure. Because each nidus includes a variety of anomalous angioarchitectural features, there should be different means and a combination of treatments for each patient. Embolization alone could be adequate treatment in relatively small lesions, the nidi of which consist only of several large fistulae. For malformations with more extensive, large fistulae or with anomalous components other than large fistulae, a combined endovascular and surgical approach and scalp reconstruction seems to be the best treatment.

Adult↗
PubMed1997

The cross-sectional size and shape of human terminal scalp hair.

Change in size of the hair shaft with distance form the scalp has been investigated, using a rotatory profile method of diameter measurement, in terminal human scalp hair of long-haired young Caucasian women. As the whole length of hairs having completed anagen are rarely found intact, two types of hair were investigated: those including segments produced at the onset of anagen ('anagen hairs'), and those including segments produced at the end of anagen ('telogen hairs'). In addition, a method of determining the cause of any size variation has been described and employed. Changes were found in the major axis of the hair cross-section, cross-sectional area and ellipticity with distance from the scalp, while the minor cross-sectional axis remained constant. It was established that these changes were the result of intrafollicular rather than extrafollicular mechanisms. Finally, a composite picture of the cross-sectional size and shape of the 'average' whole anagen hair of the study has been constructed. From the distal tip towards the scalp for approximately 6-8 cm, there was an abrupt increase in size, representing a starting-up phase of early anagen. Following this, the hair was at its greatest cross-sectional size and ellipticity which then progressively decreased through anagen (20% decrease for cross-sectional area and 13% for ellipticity). In contrast, the minor axis of the hair cross-section, remained constant throughout anagen. The hair was not therefore a uniformly sized cylinder. It was approximately spear-shaped, being broadened out in one plane distally where it was more elliptical. Subsequently as anagen progressed the hair shaft became smaller and more circular.

Female↗